Individual
DR. JAMES P WIYGUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
5340 POPLAR AVE, SUITE #1, MEMPHIS, TN 38119-3516
(901) 682-4007
(901) 683-4124
Mailing address
5340 POPLAR AVE, SUITE #1, MEMPHIS, TN 38119-3516
(901) 682-4007
(901) 683-4124
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS3263
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4071304
BC/BS PROVIDER #
TN
01
—
62-1111119
TAX ID
TN
01
—
638660
UNITED CONCORDIA PROVIDER
—
Enumeration date
07/27/2006
Last updated
06/11/2014
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